Hydrocele

http://www.nlm.nih.gov/medlineplus/ency/article/000518.htmA hydrocele is a fluid-filled

sack along the spermatic cord within the scrotum.

Causes
Hydroceles are common in newborn infants.
During normal development, the testicles descend down a tube from the abdomen into the
scrotum. Hydroceles result when this tube fails to close. Fluid drains from the abdomen
through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This
causes the scrotum to become swollen.
Hydroceles normally go away a few months after birth, but their appearance may worry new
parents. Occasionally, a hydrocele may be associated with an inguinal hernia.
Hydroceles may also be caused by inflammation or injury of the testicle or epididymis, or by
fluid or blood blockage within the spermatic cord. This type of hydrocele is more common in
older men.

Symptoms
The main symptom is a painless, swollen testicle , which feels like a water balloon. A
hydrocele may occur on one or both sides.

Exams and Tests

During a physical exam, the doctor usually finds an swollen scrotum that is not tender. Often,
the testicle cannot be felt because of the surrounding fluid. The size of the fluid-filled sack
can sometimes be increased and decreased by pressure to the abdomen or the scrotum.
If the size of the fluid collection varies, it is more likely to be associated with an inguinal
hernia.
Hydroceles can be easily demonstrated by shining a flashlight (transillumination) through the
enlarged portion of the scrotum. If the scrotum is full of clear fluid, as in a hydrocele, the
scrotum will light up.
An ultrasound may be done to confirm the diagnosis.

Treatment
Hydroceles are usually not dangerous, and they are usually only treated when they cause
discomfort or embarrassment, or if they are large enough to threaten the testicle's blood
supply.

One option is to remove the fluid in the scrotum with a needle, a process called aspiration.
However, surgery is generally preferred. Aspiration may be the best alternative for people
who have certain surgical risks.
Sclerosing (thickening or hardening) medications may be injected after aspiration to close off
the opening. This helps prevent the future build up of fluid.
Hydroceles associated with an inguinal hernia should be repaired surgically as quickly as
possible. Hydroceles that do not go away on their own over a period of months should be
evaluated for possible surgery. A surgical procedure, called a hydrocelectomy, is often
performed to correct a hydrocele.

Outlook (Prognosis)
Generally, a simple hydrocele goes away without surgery. If surgery is necessary, it is a
simple procedure for a skilled surgeon, and usually has an excellent outcome.

Possible Complications
Complications may occur from hydrocele treatment.
Risks related to hydrocele surgery may include:

Blood clots

Infection

Injury to the scrotal tissue or structures

Risks related to aspiration and sclerosing may include:

Infection

Fibrosis

Mild-to-moderate pain in the scrotal area

Return of the hydrocele

Update Date: 12/15/2010

Updated by: Erik T. Goluboff, MD, Professor, Department of Urology, College of Physicians
and Surgeons, Columbia University, New York, NY. Review provided by VeriMed Healthcare
Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

http://bedahurologi.wordpress.com/2008/06/22/hidrokel/
Hidrokel, hydroceles adalah penumpukan cairan yang berlebihan di antara lapisan parietalis
dan viseralis tunika vaginalis. Dalam keadaan normal, cairan yang berada di dalam rongga itu
memang ada dan berada dalam keseimbangan antara produksi dan reabsorbsi oleh sistem
limfatik di sekitarnya.

Etiologi
Hidrokel yang terjadi pada bayi baru lahir dapat disebabkan karena: (1) belum sempurnanya
penutupan prosesus vaginalis sehingga terjadi aliran cairan peritoneum ke prosesus vaginalis
(hidrokel komunikans) atau (2) belum sempurnanya sistem limfatik di daerah skrotum dalam
melakukan reabsorbsi cairan hidrokel.
Pada orang dewasa, hidrokel dapat terjadi secara idiopatik (primer) dan sekunder. Penyebab
sekunder terjadi karena didapatkan kelainan pada testis atau epididimis yang menyebabkan
terganggunya sistem sekresi atau reabsorbsi cairan di kantong hidrokel. Kelainan pada testis
itu mungkin suatu tumor, infeksi, atau trauma pada testis/epididimis.
Gambaran klinis
Pasien mengeluh adanya benjolan di kantong skrotum yang tidak nyeri. Pada pemeriksaan
fisis didapatkan adanya benjolan di kantong skrotum dengan konsistensi kistus dan pada
pemeriksaan penerawangan menunjukkan adanya transiluminasi. Pada hidrokel yang
terinfeksi atau kulit skrotum yang sangat tebal kadang-kadang sulit melakukan pemeriksaan
ini, sehingga harus dibantu dengan pemeriksaan ultrasonografi. Menurut letak kantong
hidrokel terhadap testis, secara klinis dibedakan beberapa macam hidrokel, yaitu (1) hidrokel
testis, (2) hidrokel funikulus, dan (3) hidrokel komunikan. Pembagian ini penting karena
berhubungan dengan metode operasi yang akan dilakukan pada saat melakukan koreksi
hidrokel.

Pada hidrokel testis, kantong hidrokel seolah-olah mengelilingi testis sehingga testis
tak dapat diraba. Pada anamnesis, besarnya kantong hidrokel tidak berubah sepanjang
hari.

Pada hidrokel funikulus, kantong hidrokel berada di funikulus yaitu terletak di sebelah
kranial dari testis, sehingga pada palpasi, testis dapat diraba dan berada di luar
kantong hidrokel. Pada anamnesis kantong hidrokel besarnya tetap sepanjang hari.

Pada hidrokel komunikan terdapat hubungan antara prosesus vaginalis dengan rongga
peritoneum sehingga prosesus vaginalis dapat terisi cairan peritoneum. Pada
anamnesis, kantong hidrokel besarnya dapat berubah-ubah yaitu bertambah besar
pada saat anak menangis. Pada palpasi, kantong hidrokel terpisah dari testis dan dapat
dimasukkan ke dalam rongga abdomen.

Terapi
Hidrokel pada bayi biasanya ditunggu hingga anak mencapai usia 1 tahun dengan harapan
setelah prosesus vaginalis menutup, hidrokel akan sembuh sendiri; tetapi jika hidrokel masih
tetap ada atau bertambah besar perlu difikirkan untuk dilakukan koreksi.

Tindakan untuk mengatasi cairan hidrokel adalah dengan aspirasi dan operasi. Aspirasi cairan
hidrokel tidak dianjurkan karena selain angka kekambuhannya tinggi, kadang kala dapat
menimbulkan penyulit berupa infeksi.
Beberapa indikasi untuk melakukan operasi pada hidrokel adalah: (1) hidrokel yang besar
sehingga dapat menekan pembuluh darah, (2) indikasi kosmetik, dan (3) hidrokel permagna
yang dirasakan terlalu berat dan mengganggu pasien dalam melakukan aktivitasnya seharihari.
Pada hidrokel kongenital dilakukan pendekatan inguinal karena seringkali hidrokel ini
disertai dengan hernia inguinalis sehingga pada saat operasi hidrokel, sekaligus melakukan
herniorafi. Pada hidrokel testis dewasa dilakukan pendekatan skrotal dengan melakukan
eksisi dan marsupialisasi kantong hidrokel sesuai cara Winkelman atau plikasi kantong
hidrokel sesuai cara Lord. Pada hidrokel funikulus dilakukan ekstirpasi hidrokel secara in
toto

http://www.mayoclinic.com/health/hydrocele/DS00617
Nov. 19, 2009

Definition
By Mayo Clinic staff
A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum,
the loose bag of skin underneath the penis. Up to 10 percent of male infants have a hydrocele
at birth, but most hydroceles disappear without treatment within the first year of life.
Additionally, adult men can develop a hydrocele due to inflammation or injury within the
scrotum.
Hydroceles usually aren't painful. Typically not harmful, hydroceles may require no
treatment. However, if you have scrotal swelling, see your doctor to rule out other causes,
such as testicular cancer or other conditions.
Symptoms
Usually the only indication of a hydrocele is a painless swelling of one or both testicles.
Adult men with a hydrocele may experience discomfort from the heaviness of a swollen
scrotum.
Causes
In older males, a hydrocele can develop as a result of inflammation or injury
within the scrotum. Inflammation may be the result of infection of the small
coiled tube at the back of each testicle (epididymitis) or of the testicle.

Complications

A hydrocele typically isn't dangerous and usually doesn't affect fertility. However, it may be
associated with an underlying testicular condition that may cause serious complications:

Infection or tumor. Either may reduce sperm production or function.

Inguinal hernia. A loop of intestine could become trapped in the weak point in the
abdominal wall (strangulated), a life-threatening condition.

Tests and diagnosis

Your doctor will do a physical exam. The exam may reveal an enlarged scrotum that isn't
tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled
sac, which may indicate an associated inguinal hernia.
Because the fluid in a hydrocele usually is clear, your doctor may shine a light through the
scrotum (transillumination). With a hydrocele, the light will outline the testicle, indicating
that clear fluid surrounds it.
If your doctor suspects your hydrocele is caused by inflammation, blood and urine tests may
help determine whether you have an infection, such as epididymitis.
The fluid surrounding the testicle may keep the testicle from being felt. In that case, you may
need an ultrasound imaging test. This test, which uses high-frequency sound waves to create
images of structures inside your body, can rule out a hernia, testicular tumor or other cause of
scrotal swelling.
Treatments and drugs
For adult males as well, hydroceles often go away on their own. A hydrocele requires
treatment only if it gets large enough to cause discomfort or disfigurement. Then it may need
to be removed.
Treatment approaches include:

Surgical excision (hydrocelectomy). Removal of a hydrocele may be performed on

an outpatient basis using general or spinal anesthesia. The surgeon may make an
incision in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is
discovered during surgery to repair an inguinal hernia, your doctor may remove it
even if it's causing you no discomfort.

A hydrocelectomy may require you to have a drainage tube and wear a bulky dressing over
the site of the incision for a few days after surgery. Also, you may be advised to wear a
scrotal support for a time after surgery. Ice packs applied to the scrotal area during the first 24
hours after surgery may help reduce swelling. Surgical risks include blood clots, infection or
injury to the scrotum.

Needle aspiration. Another option is to remove the fluid in the scrotum with a needle.
This treatment isn't widely used because it's common for the fluid to return. The
injection of a thickening or hardening (sclerosing) drug after the aspiration may help

prevent the fluid from reaccumulating. Aspiration and injection may be an option for
men who have risk factors that make surgery more dangerous. Risks of this procedure
include infection and scrotal pain.
Sometimes, a hydrocele may recur after treatment.